Advanced Health Assessment Midterm Review: Quiz Questions & Answers, Exams of Nursing

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Advanced Health Assessment Midterm

2024-2025 Review of Quiz Questions &

Answers.

A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon physical examination, there is a red raised area at the margin of the eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the most likely diagnosis?

Dacryocystitis

Chalazion

Hordeolum

Xanthelasma - ANSHordeolum

A 19-year-old college student, Todd, is brought to your clinic by his mother. She is concerned that there is something seriously wrong with him. She states for the past 6 months his behavior has become peculiar and he has flunked out of college. Todd denies any recent illness or injuries. His past medical history is remarkable only for a broken foot. His parents are both healthy. He has a paternal uncle who had similar symptoms in college. The patient admits to smoking cigarettes and drinking alcohol. He also admits to marijuana use but none in the last week. He denies using any other substances. He denies any feelings of depression or anxiety. While speaking with Todd and his mother you do a complete physical examination, which is essentially normal. When you question him on how he is feeling, he says that he is very worried that Microsoft has stolen his software for creating a better browser. He tells you he has se - ANSSchizophrenia

A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat more than before because being outdoors is part of his job. On physical examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is your most likely diagnosis?

Tinea versicolor

Pityriasis rosea

Psoriasis

Atopic eczema - ANSTinea versicolor

A 21-year-old college senior presents to your clinic, complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way with extreme exercise a few years ago and used to have to use some kind of inhaler 20 minutes before exercise. She denies any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is significant only for seasonal allergies, for which she takes a nasal steroid spray but is otherwise on no other medications. She has had no surgeries. Her mother has allergies and eczema and her father has high blood pressure. She is an only child. She denies smoking and illegal drug use but drinks three to four alcoholic beverages per weekend. She is a junior in finance at a local university and she has recently started a job as a bartender in town. On examination she is in no acute distress and her tempera - ANSAsthma

A 25-year-old optical technician comes to your clinic for evaluation of fatigue. As part of your physical examination, you listen to her heart and hear a murmur only at the cardiac apex. Which valve is most likely to be involved, based on the location of the murmur?

Mitral

Tricuspid

Aortic

Pulmonic - ANSMitral

A 27-year-old policewoman comes to your clinic, complaining of severe left-sided back pain radiating down into her groin. It began in the middle of the night and woke her up suddenly. It hurts in her bladder to urinate but she has no burning on the outside. She has had no frequency or urgency with urination but she has seen blood in her urine. She has had nausea with the pain but no vomiting or fever. She denies any other recent illness or injuries. Her past medical history is unremarkable. She denies tobacco or drug

use and drinks alcohol rarely. Her mother has high blood pressure and her father is healthy. On examination she looks her stated age and is in obvious pain. She is lying on her left side trying to remain very still. Her cardiac, pulmonary, and abdominal examinations are unremarkable. She has tenderness just inferior to the left costovertebral angle. Her urine pregnancy test is negative and her urine anal - ANSureteral pain from a stone

A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis?

Tinea versicolor

Pityriasis rosea

Psoriasis

Atopic eczema - ANSPityriasis rosea

A 29-year-old physical therapist presents for evaluation of an eyelid problem. On observation, the right eyeball appears to be protruding forward. Based on this description, what is the most likely diagnosis?

Ptosis

Ectropion

Epicanthus

Exophthalmos - ANSExophthalmos

A 32-year-old white female comes to your clinic, complaining of overwhelming sadness. She says for the past 2 months she has had crying episodes, difficulty sleeping, and problems with overeating. She says she used to go out with her friends from work but now she just wants to go home and be by herself. She also thinks that her work productivity has been dropping because she just is too tired to care or concentrate. She

denies any feelings of guilt or any suicidal ideation. She states that she has never felt this way in the past. She denies any recent illness or injuries. Her past medical history consists of an appendectomy when she was a teenager; otherwise, she has been healthy. She is single and works as a clerk in a medical office. She denies tobacco, alcohol, or illegal drug use. Her mother has high blood pressure and her father has had a history of mental illness. On examination you see a woman appearing her st - ANSMajor depressive episode

A 38-year-old accountant comes to your clinic for evaluation of a headache. The throbbing sensation is located in the right temporal region and is an 8 on a scale of 1 to

10. It started a few hours ago, and she has noted nausea with sensitivity to light; she has had headaches like this in the past, usually less than one per week, but not as severe. She does not know of any inciting factors. There has been no change in the frequency of her headaches. She usually takes an over-the-counter analgesic and this results in resolution of the headache. Based on this description, what is the most likely diagnosis of the type of headache?

Tension

Cluster

Migraine

Analgesic rebound - ANSMigraine

A 52-year-old secretary comes to your office, complaining about accidentally leaking urine when she coughs or sneezes. She says this has been going on for about a year now. She relates that she has not had a period for 2 years. She denies any recent illness or injuries. Her past medical history is significant for four spontaneous vaginal deliveries. She is married and has four children. She denies alcohol, tobacco, or drug use. During her pelvic examination you note some atrophic vaginal tissue, but the remainder of her pelvic, abdominal, and rectal examinations are unremarkable.

Which type of urinary incontinence does she have?

stress

urge

overflow

neurologic - ANSstress

A 62-year-old construction worker presents to your clinic, complaining of almost a year of chronic cough and occasional shortness of breath. He denies any chest pain. He has had no weight gain, weight loss, fever, or night sweats. His past medical history is significant for high blood pressure and arthritis. He has smoked two packs a day for the past 45 years. He drinks occasionally but denies any illegal drug use. He is married and has two children. He denies any foreign travel. His father died of a heart attack and his mother died of Alzheimer's disease. On examination you see a man looking slightly older than his stated age. His blood pressure is 130/80 and his pulse is 88. His head, eyes, ears, nose, and throat examinations are unremarkable. His cardiac examination is normal. On examination of his chest, the diameter seems enlarged. Breath sounds are decreased throughout all lobes. Rhonchi are heard over all lung - ANSChronic obstructive pulmonary disease (COPD)

A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis?

Seborrheic keratosis

Actinic keratosis

Basal cell carcinoma

Squamous cell carcinoma - ANSActinic keratosis

A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer?

Stage 1

Stage 2

Stage 3

Stage 4 - ANSStage 3

A 72-year-old teacher comes to your clinic for an annual examination. She is concerned about her risk for peripheral vascular disease and states that there is a place in town that does tests to let her know her if she has this or not. Which of the following disease processes is a risk factor for peripheral vascular disease?

Gastroesophageal reflux disease

Coronary artery disease

Migraine headaches

Osteoarthritis - ANSCoronary artery disease

A basal cell carcinoma is:

an epithelial tumor that originates from either the basal layer of the epidermis or cells in the surrounding dermal structures and are usually found in sun-exposed areas

a malignant tumor of the squamous epithelium of the skin or mucous membranes

an overgrowth and thickening of the cornified epithelium

lined with epithelium and contains a fluid or semisolid material - ANSan epithelial tumor that originates from either the basal layer of the epidermis or cells in the surrounding dermal structures and are usually found in sun-exposed areas

A careful history of a client with a chief complaint of diarrhea reveals that this adult has recurrent abdominal pain and diarrhea that alternates with constipation. The symptoms have been present >6 months and the client also reports change in stool frequency and appearance. This most likely represents:

drug-induced diarrhea

inflammatory bowel disease

giardiasis

irritable bowel syndrome - ANSirritable bowel syndrome

A classic assesment of patient with angina pectoris would include the following:

exertional pain

chest pressure

discomfort in the shoulder, back, neck or arm

all of the above - ANSall of the above

A client is complaining of dyspnea. During your subjective assessment, you are able to best assess the degree the patient's dyspnea by asking about:

age

severity based on the patient's daily activities

body weight

height - ANSseverity based on the patient's daily activities

A fibroadenoma is known as a benign breast tumor.

True

False - ANStrue

A healthy BMI can best be described as:

A. 18.5-24.

B. 30.0-34.

C. 25.0-29.

D. 35.0-39.9 - ANSA. 18.5-24.

A middle aged pateint presents with diffuse facial swelling. Upon further assessment of the face you note hair is dry, course and sparse; thinning of lateral eyebrows; periorbital edema. This represents a finding of:

Cishing's syndrome

Myxedema

Nephrotic syndrome

Angioedema - ANSMyxedema

A patient complains of shortness of breath for the past few days. On examination, you note late inspiratory crackles in the lower third of the chest that were not present a week ago. What is the most likely explanation for these?

Heart failure

Asthma

COPD

Bronchiectasis - ANSHeart failure

A patient with abdominal pain describes "what" the pain feels like and "how long" it lasts. In which part of the H&P would you place this information?

A. History of Present Illness

B. Past Medical History C. Sexual History D. Review of Systems - ANSA. History of present illness

A skin and tissue disorder usually caused by increased adrenal cortisol production; characterized by round or "moon" face appearance is:

myxedema

acromegaly

cushing's syndrome

nephrotic syndrome - ANScushing's syndrome

All of the following are characteristics of the assessment of breast nodules except:

location

size

shape

color - ANScolor

All of the following are considered bony landmarks of the eardrum except:

cone of light

short process of the malleus

handle of the malleus

umbo - ANScone of light

All of the following are examples of empathic responses except:

A. "I cannot imagine how hard this must be for you" B. "I think you need a psych consult immediately" C. "You must be feeling sad" D. "That sounds upsetting" - ANSB. "I think you need a psych consult immediately"

All of the following are examples of health promotion except:

A. using USPSTF guidelines for practice during the exam B. using American College of Chest Physicians grading criteria during the exam C. removing baby aspirin 81 mg from the medication list of a patient with know coronary artery disease during the exam D. using CDC recommendations for exercise during the exam - ANSC. removing baby aspirin 81 mg from the medication list of a patient with know coronary artery disease during the exam

All of the following are included in the Review of Systems except:

A. general B. Cardiovascular C. Psychiatric D. All of the above - ANSD. All of the above

An abnormal finding during the peripheal arterial examination would include:

symmetric pulses

symmetric blood pressures

asymmetric blood pressures

abscence of claudication - ANSasymmetric blood pressures

An assessment of a client experiencing hallucinations would most likely reveal all of the following except:

experiences that seem real but lack actual external stimulation

may be auditory

may be visual

only occurs in the setting of schizophrenia - ANSonly occurs in the setting of schizophrenia

An elderly client presents with fever, leukocytosis and cramps. Upon physical exam you find lower left quadrant tenderness. The most likely diagnosis is:

appendicitis

diverticulitis

irritable bowel syndrome

pancreatitis - ANSdiverticulitis

Assessment of pitting edema in the foot should include pressing firmly but gently with your thumb for at least 2 seconds over all of the following areas except:

Incorrect Response

the dorsum of each foot

the plantar surface of the heel

behind each medial malleolus

over the shins - ANSthe plantar surface of the heel

CDC guidelines recommend smoking prevention and cessation should begin when a patient is:

A middle-aged female

A geriatric male

A teenager

Of legal drinking age - ANSA teenager

Colorectal cancer is the third most common cancer in men only.

True False - ANSFalse

Dave, age 76, is brought in by his wife, who states that within the last 2 days Dave has become agitated and restless, has had few lucid moments, slept very poorly last night and can remember only recent events. Of the following differential diagnoses, which best fits the symptoms from this brief history?

A. Depression B. Dementia C. Delirium D. Schizophrenia - ANSC. Delirium

During a mental status exam, which question might you ask to assess abstraction ability?

A. What does a rolling stone gathers no moss mean? B. Start with 100 and keep subtracting by 7 C How long have you been here? D. What's your mother's maiden name? - ANSA. What does a rolling stone gathers no moss mean?

During a patient's pain assessment, the most important element is the patient's:

A. Sleep hygiene B. Perception of his/her own pain C. Vital signs D. Fear of addiction - ANSB. Perception of his/her own pain

During an interview, your patient admits to feeling worthless and having a sleep disturbance for the last 3 weeks. These are clues that warrant exploration of:

A. risk for suicide B. split personality C. cognitive function D. functional assessment - ANSA. risk for suicide

Enlarged or tender lymphnodes, if unexplained, call for:

Immediate biopsy

Re-examination of the regions they drain

Immediate soft-tissue CT

Stat referral to ENT - ANSRe-examination of the regions they drain

Functional incontinence may arise from impaired cognition, musculoskeletal problems or immobility.

True False - ANSTrue

How should you determine whether a murmur is systolic or diastolic?

Palpate the carotid pulse.

Palpate the radial pulse

Judge the relative length of systole and diastole by auscultation.

Correlate the murmur with a bedside heart monitor. - ANSPalpate the carotid pulse.

Jaxson is a 10 year-old male patient that presents to the clinic today complaining of a headache. His mother reports that he has just not been acting himself for the past two days. All of the following would be pertinent in your examination, except:

Assessing for cranial trauma or deformity

Incorrect Response

Assessing for nuchal rigidity

Assessing for cervical spine tenderness or deformity

Assessing for Jugular Vein Distension - ANSAssessing for Jugular Vein Distension

Mr. Patel is a 64-year-old man who was told by another care provider that his liver is enlarged. Although he is a life-long smoker, he has never used drugs or alcohol and has no knowledge of liver disease. Indeed, on examination, a liver edge is palpable 4 centimeters below the costal arch. Which of the following would you do next?

order a liver ultrasound

order a hepatitis panel

determine liver span by percussion

oder a stat GI referral - ANSdetermine liver span by percussion

Nail involvement characterized by painless separation of the nail plate from the nail bed is termed:

Hippocratic nails

Onycholysis

Koilonychia

Anonychia - ANSOnycholysis

One of the main differences between a comprehensive and focused assessment is:

A. for the comprehensive assessment you will select the methods relevant to thorough assessment of the targeted problem B. for the focused assessment you will select the methods relevant to thorough assessment of the targeted problem C. for the focused assessment you perform a thorough head to toe examination D. for the comprehensive assessment you always refer the patient to a specialist at the end of the examination - ANSB. for the focused assessment you will select the methods relevant to thorough assessment of the targeted problem

Orthopnea is differentiated from other forms of dyspnea as it:

occurs when the patient is lying down and improves when the patient sits up

occurs when the patient is lying down and improves when the rolls over

occurs when the patient is sitting up and improves when the patient lays down

is always accompanied by heart palpitations - ANSoccurs when the patient is lying down and improves when the patient sits up

Risk factors for fatal overdose of pain medications include all of the following except:

A. age 65 or older B. depression C. arthritis D. concurrent benzodiazepine use - ANSC. arthritis

Sammy, age 12, presents with claerly demarcated round or oval patches of hair loss without visible scaling or inflammation. What do you suspect?

Psoriasis

Erythema multiforme

Alopecia Areata

Syphilis - ANSAlopecia Areata

Small, mobile, discrete, non-tender nodes are termed:

shotty

fluctuant

matted

fixed - ANSshotty

Symptoms and assessment findings related to hypothyroidism include all of the following except:

Palpitations

Fatigue

Dry, coarse skin

Cold intolerance - ANSPalpitations

The comprehensive health history:

A. has a completely different format that varies with each institution B. varies from country to country C. follows the same general format regardless of the institution or geographical location D. follows the exact same format across the world, except Europe - ANSC. follows the same general format regardless of the institution or geographical location

The consideration of culture and ethnicity during the interview process are important because:

A. similar cultures always provide similar responses B. some cultures consider certain questions and gestures offensive

C. it is politically correct D. none of the above - ANSB. some cultures consider certain questions and gestures offensive

The following are examples of transmitted voice sounds except:

ask the patient to say their name and then repeat it again backwards

ask the patient to say "ninety-nine"

ask the patient to whisper "one-two-three"

as the patient to say "ee" - ANSask the patient to say their name and then repeat it again backwards

The following information belongs in which section of the Comprehensive Heath History (H&P)?

"3 day history of rash and swelling"

A. History of Present Illness B. Review of Systems C. Allergies D. Chief Complaint - ANSD. Chief Complaint

The general survey of the patient includes all of the following except:

A. appearance B. tanner stage C. height D. weight - ANSB. tanner stage

The initial moments of your encounter with a patient lay the foundation for your ongoing relationship. Which of the following best helps lay that foundation:

A. ensure there is more than adequate lighting in the exam room B. explain your role, your status as a student provider and how you will be involved in the patient's care C. check the light source in the otoscope

D. check the light source in the opthalmascope - ANSB. explain your role, your status as a student provider and how you will be involved in the patient's care

The mental status examination enables the nurse practitioner to identify:

Intelligence quotient and reasoning

Abstract thinking and memory functioning

Reasoning and psychomotor skills

Memory functioning and intelligence - ANSAbstract thinking and memory functioning

The nurse practitioner is completing a history and physical on a child who she suspects may be autistic. Findings associated with autism include:

Delay in language development

Delay in physical growth

Overprotective parents who provide minimal social interaction for the child

Warm, cuddling child with excessive need for interaction. - ANSDelay in language development

The nurse practitioner is examining an adolescent who has been a long-term IV cocaine user. What other findings would alert the nurse practitioner to a frequent complication.

Epistaxis and chronic rhinorrhea

Cardiac arrhythmias and hypertension

Chest congestion and wheezing

Hepatitis and cellulitis - ANSHepatitis and cellulitis

The test that compares air conduction and bone conduction is known as:

Weber test

Whispered voice test

Tug tes

Rinne test - ANSRinne test

The thyroid gland is best assessed:

above the hyoid bone

behind the cricoid

below the suprasternal notch

The thyroid gland is best assessed:

above the hyoid bone

behind the cricoid

below the suprasternal notch

Correct Response

above the suprasternal notch - ANSabove the suprasternal notch

Thrush is most often characterized as:

white exudate on the tonsils

thick, white plaques adhering to the underllying mucosa

white specks found only on the buccal mucosa

fissures on the tongue - ANSthick, white plaques adhering to the underllying mucosa

To differentiate among the different diagnoses of imflammatory bowel diseases, you look at the client's histological, culture and physical features. Mary has transmural inflammation, granulomas, focal involvement of the colon with some skipped areas, involving the terminal ileum and proximal colon. What do you suspect:

crohn's disease

ulcerative colitis

infectious colitis

ischemic colitis - ANScrohn's disease

To hear a soft murmur or bruit, which of the following may be necessary?

Ask the patient to hold their breath

Ask the patient to silence their cell phone

Check the tubing of your stethescope for any cracks that could cause an air leak

All of the above - ANSAll of the above

Tonsillar lymphnodes are located:

at the angle of the mandible

in the midline, a few centimeters behind the tip of the mandible

behind the tonsilis in the oropharynx

superficial to the sternomastoid - ANSat the angle of the mandible

Types of ocular discharge found in the setting of conjunctivitis include all of the following except:

hemorrhagic

mucoid

mucoidpurulent

watery - ANShemorrhagic

Visceral pain is best described as:

pain that originates from the parietal peritoneum

pain that occurs when organs contract unusually and forcefully or are distended and stretched

pain that is felt in distant sites

pain that is felt after a loose bowel movement - ANSpain that occurs when organs contract unusually and forcefully or are distended and stretched

What is the correct procedure for palpation of a client's thyroid gland?

stand behind the client, hyperextend th head and palpate both sides simultaneoulsy

stand behind the client, have the client flex the neck slightly forward to relax the sternomastoid muscles

stand in front of the client, hyperextend the head and have the client lean away from the side being evaluated

stand next to the client and have the cliient lean away from the side being examined and take a swallow of water - ANSstand behind the client, have the client flex the neck slightly forward to relax the sternomastoid muscles

What is the most common origination of melena:

esophagus

stomach

duodenum

all of the above - ANSall of the above

When a client sips water and swallows, the thyroid isthmus:

moves down and slightly posterior and feels smooth on palpation

elongates and enlarges during the swallow and immediately returns to a resting position

moves slightly out during the sipping and backward during the swallowing

moves upward during the swallow and feels symmetric and smooth to palpation - ANSmoves upward during the swallow and feels symmetric and smooth to palpation

When assessing a patient for cardiovascular disease, you are aware that it strikes a disproportionate number of:

hispanics and women

native americans and men

african americans and women

african americans and men - ANSafrican americans and women

When assessing a patient for peripheal arterial disease (PAD), it is important to ask about all of the following except:

leg coldness

leg numbness

leg length

loss of hair over the anterior tibial surfaces - ANSleg length

When assessing for DVT using Homan sign you understand that evaluating for discomfort behind the knee with forced dorsiflexion on the foot is neither sensitive or specific and discredited by Homan himself.

True False - ANSTrue

When grading the amplitude of arterial pulses, brisk (or normal) pulses would be:

3+

2+

1+

0 - ANS2+

When performing an examination using the opthalmoscope, place yourself about 15 inches away from the patient and at a 15 degree angle from the patient's line of vision. The first thing that should come into view is called:

physiologic cup

Red Reflex

optic disc

papilledema - ANSRed Reflex

When performing the general survey which of the following is not considered a sign of distress:

A. pain B. labored breathing C. large mole on forehead D. anxiety - ANSC. large mole on forehead

Where is the point of maximal impulse (PMI) normally located?

In the left 5th intercostal space, 7 to 9 cm lateral to the sternum

In the left 5th intercostal space, 10 to 12 cm lateral to the sternum

In the left 5th intercostal space, in the anterior axillary line

In the left 5th intercostal space, in the midaxillary line - ANSIn the left 5th intercostal space, 7 to 9 cm lateral to the sternum

Which is the most effective pattern of palpation for breast cancer?

Beginning at the nipple, make an ever-enlarging spiral.

Examine in lines resembling the back and forth pattern of mowing a lawn.

Divide the breast into quadrants and inspect each systematically.

Beginning at the nipple, palpate outward in a stripe pattern. - ANSExamine in lines resembling the back and forth pattern of mowing a lawn.

Which is the proper sequence for examination of the abdomen:

Auscultation, inspection, palpation, percussion

Inspection, percussion, palpation, auscultation

Inspection, auscultation, percussion, palpation

Auscultation, percussion, inspection, palpation - ANSInspection, auscultation, percussion, palpation

Which lung sound possesses the characteristics of being louder and higher in pitch, with a short silence between inspiration and expiration and with expiration being longer than inspiration?

Bronchial

Bronchovesicular

Vesicular

Tracheal - ANSBronchial

Which of the following are associated causes of epistaxis:

anticoagulants

nsaids

coagulopathies

all of the above - ANSall of the above

Which of the following are common characteristics of acute otitis media: